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Changes in all-cause and cause-specific mortality by occupational skill during COVID-19 epidemic in Spain
  1. Damián González-Beltrán1,
  2. Marta Donat1,
  3. Julieta Politi1,
  4. Elena Ronda2,3,
  5. Gregorio Barrio1,3,
  6. María José Belza1,3,
  7. Enrique Regidor4
  1. 1National School of Public Health, Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
  2. 2Preventive Medicine and Public Health Area, Universidad de Alicante, Alicante, Spain
  3. 3CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  4. 4Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
  1. Correspondence to Damián González-Beltrán, National School of Public Health, Instituto de Salud Carlos III, Madrid 28029, Spain; damianglezbel{at}


Background There is little information on the differential impact of the COVID-19 pandemic on mortality by occupation. The objective was to examine changes in mortality during the COVID-19 period compared with the prepandemic period in different occupational groups in Spain.

Methods Average mortality in the entire period 2020–2021, and each of its semesters, was compared, respectively, with the average mortality in the entire period 2017–2019, and the corresponding semester (first or second) of this last period, across occupational skill levels. For this, age-standardised death rates and age-adjusted mortality rate ratios (MRRs) obtained through Poisson regression were used. Data were obtained from the National Institute of Statistics and the Labour Force Survey.

Results The excess all-cause mortality during the 2020–2021 pandemic period by the MRR was higher in low-skilled (1.18, 95% CI 1.16 to 1.20) and medium-skilled workers (1.14; 95% CI 1.13 to 1.15) than high-skilled workers (1.04; 95% CI 1.02 to 1.05). However, the greatest excess mortality was observed in low-skilled workers in 2020 and in medium-skilled workers in 2021. Focusing on causes of death other than COVID-19, low-skilled workers showed the highest MRR from cardiovascular diseases (1.31; 95% CI 1.26 to 1.36) and high-skilled workers the lowest (1.02; 95% CI 0.98 to 1.02). However, this pattern was reversed for mortality from external causes, with low-skilled workers showing the lowest MRR (1.04; 95% CI 0.97 to 1.09) and high-skilled workers the highest (1.08; 95% CI 1.03 to 1.13).

Conclusion Globally, in Spain, during the 2020–2021 COVID-19 epidemic period, low-skilled workers experienced a greater excess all-cause mortality than other occupational groups, but this was not the case during the entire epidemic period or for all causes of death.

  • COVID-19

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors DG-B and MD designed the study, collected data, did the analyses and drafted the manuscript. JP and ERo contributed to statistical analysis and data management. GB, MJB and ERe revised the manuscript and provided intellectual content. All authors contributed to the interpretation of the results. All authors have seen and approved the final version.

  • Funding Spanish Ministry of Health, National Drug Plan (2021I034); a grant (ENPY 136/22-M3 FORMATIVO-2) from the Instituto de Salud Carlos III, Madrid, Spain

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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